Healthcare Provider Details

I. General information

NPI: 1396840658
Provider Name (Legal Business Name): PAMELA SUE PALME CRNA,MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 HOLY CROSS LN
BREESE IL
62230-3618
US

IV. Provider business mailing address

504 KATHY LN
NEW BADEN IL
62265-2025
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-5329
  • Fax: 618-526-2291
Mailing address:
  • Phone: 618-910-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041314944
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209004248
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: